In a judgment dated 16 September 2026, the Sixth Civil Decision Chamber of the Superior Court of Bogotá (the “Court”) upheld a decision issued by the Colombian Financial Superintendence (“SFC”) ordering an insurer to pay benefits under a group life insurance policy. The Court found that the insurer had failed to establish the requirements necessary to deny coverage based on alleged pre-existing conditions and that the alleged non-disclosure (reticence) by the insured had not been proven.
The policyholder under the group life insurance policy was a banking institution, to which the claimant became affiliated as an insured through a digital enrolment process. The enrolment was handled by a sales representative of the bank, who merely sent the insured a one-time password (OTP) to complete the enrolment process and provided access to the policy, the general terms and conditions, and a welcome message. However, there was no evidence that the insurer had clearly and comprehensibly explained the policy exclusions and coverage limitations to the insured.
A Regional Disability Assessment Board subsequently determined that the insured had suffered a 50.26% loss of working capacity. Nevertheless, the insurer denied the claim, arguing that the occurrence of the insured risk had not been established. Notwithstanding this defense, the SFC, acting as the court of first instance, found the insurer contractually liable and ordered it to pay the insurance proceeds together with default interest.
In deciding the insurer's appeal, the Court made the following observations:
Information duties in digital distribution Channels:
The Court clarified that the fact that the bank’s sales representative merely sent the insured an OTP to finalize the enrolment process, while making the policy documents, general conditions, and a welcome message available, was not sufficient in itself to satisfy the insurer's duty to provide information.
Pursuant to the principles of transparency and financial consumer protection set out in Law 1328 of 2009, the insurer was required to provide a clear, adequate, understandable, and timely explanation of the essential terms of the policy, particularly clauses restricting coverage, such as exclusions relating to pre-existing medical conditions:
“[…] it was incumbent on the insurer to undertake an effective informational activity aimed at explaining coverage limitations in a prominent and comprehensible manner, thereby enabling the insured to make a genuinely informed contractual decision.”
The Court emphasized that the use of digital channels and the transmission of insurance documentation through technological means do not exempt insurers from complying with this obligation. Likewise, the mass delivery of documents or electronic links does not, by itself, demonstrate that a consumer has understood their contents:
“[…] the use of digital channels and the transmission of the insurance contract through technological means do not relieve the insurer from fully complying with the aforementioned duty, nor does the mass delivery of documents or electronic links allow the conclusion, by itself, that the consumer knows and understands all of their contents.”
Although the insured has a duty to act diligently become informed about the product being purchased, that obligation neither replaces nor diminishes the insurer's professional duty to provide information:
“[…] even though the claimant had a duty to act diligently and become informed about the product acquired, such duty does not replace or lessen the professional obligation to provide information that rests upon the insurance company.”
Pre-Existing Conditions, Non-Disclosure, and the Insurer's Pre-Contractual Obligations
The Court further held that the mere existence of medical conditions predating the insurance contract does not justify a denial of coverage nor, by itself, constitute actionable non-disclosure. Relying on precedent from the Supreme Court of Justice, the Court recalled that insurers must: “exercise diligence in conducting medical examinations or require the submission of recent medical records in order to verify the true health condition of the insured; if such measures are not taken, the insurer must bear the consequences of defects, omissions, and inaccuracies.”
With respect to the alleged non-disclosure, the Court noted that its configuration: “necessarily requires bad faith conduct,” and that “mere knowledge of the illness is insufficient; the omission must result from the intention of the policyholder (or insured) to avoid making the insurance contract more onerous or to prevent the insurer from declining to enter into it.”
In the case at hand, the insurer failed to undertake any pre-contractual investigation and its legal representative acknowledged that no medical questionnaire concerning the insured's health history had been administered. Accordingly, the insurer could not shift to the insured the consequences of its own lack of diligence.
Based on these considerations, the Court affirmed the first-instance judgment ordering the insurer to pay the insured amount together with default interest and further ordered the appellant insurer to bear the costs of the appeal proceedings.